Provider Demographics
NPI:1508510850
Name:KIERNAN, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MERRICK RD APT 2B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5342
Mailing Address - Country:US
Mailing Address - Phone:516-426-4804
Mailing Address - Fax:
Practice Address - Street 1:350 MERRICK RD APT 2B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5342
Practice Address - Country:US
Practice Address - Phone:516-426-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026198-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist